Provider Demographics
NPI:1326563222
Name:BURROUGHS ABIDI, BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BETH
Middle Name:
Last Name:BURROUGHS ABIDI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 ENTERPRISE WAY STE C110
Mailing Address - Street 2:
Mailing Address - City:SCOTTS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95066-3242
Mailing Address - Country:US
Mailing Address - Phone:831-465-7800
Mailing Address - Fax:831-464-7044
Practice Address - Street 1:100 ENTERPRISE WAY STE C110
Practice Address - Street 2:
Practice Address - City:SCOTTS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95066-3242
Practice Address - Country:US
Practice Address - Phone:831-465-7800
Practice Address - Fax:831-464-7044
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG85554208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG85554OtherMEDICAL BOARD OF CALIFORNIA